Provider Demographics
NPI:1306903760
Name:WILKINSON, ROBERT MCLAIN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MCLAIN
Last Name:WILKINSON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 S HAWTHORNE RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3913
Mailing Address - Country:US
Mailing Address - Phone:336-765-9247
Mailing Address - Fax:336-765-6960
Practice Address - Street 1:1900 S HAWTHORNE RD
Practice Address - Street 2:SUITE 170
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3913
Practice Address - Country:US
Practice Address - Phone:336-765-9247
Practice Address - Fax:336-765-6960
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8999290Medicaid